American Indians have been characterized as having high rates of Fetal Alcohol Syndrome (FAS). There is, however, substantial variation in FAS prevalence from one tribe and Indian community to the next. This research will measure the prevalence of Fetal Alcohol Syndrome in four Indian communities. Furthermore, the epidemiology of drinking among adults in these four communities will also be measured from a random, community- wide sample. The goal is to determine both the prevalence of drinking among adults and women in these communities, and compare that with the level of Fetal Alcohol Syndrome prevalence produced by these drinking patterns and the characteristics of problem drinking. As there is wide variation in tribal culture from one community to the next, both the patterns of adult drinking and FAS are expected to vary. Utilizing techniques of research applied previously in other American Indian communities over the past years, and through more rigorous operationalization, this study will determine the nature of adult drinking in these four communities and the level of FAS and other alcohol-related birth defects (ARBD) produced by these patterns. It is designed to advance our knowledge about the epidemiology of adult drinking, the epidemiology of FAS, and particularly the maternal alcohol abuse risk factors among American Indians in these particular communities. The specific aims of this research are: 1) to establish the population-based prevalence and characteristics of adult drinking, 2)establish the retrospective population-based prevalence rates of FAS and alcohol related birth defects (ARBD) symptoms (in children ages 0-8), and to test conclusively the hypothesis that low social integration tribes have a higher prevalence of drinking, high risk drinking, FAS and ARBD symptoms than do high and medium social integration tribes. Ultimately, this research is designed to guide comprehensive prevention efforts carried out in American Indian communities. It will provide information for targeting specific primary, secondary, and tertiary prevention techniques, and will also serve as baseline prevalence measures which then can be assessed in a later time period to gage whether prevention efforts (not funded by this study) have succeeded. While the research is specific to four American Indian communities, results should be generally applicable to most American Indian and Alaska Native communities. Furthermore, some of the research techniques, methods, and protocols developed in this research can be adapted and transferred to non-Indian communities as well.